Healthcare Provider Details

I. General information

NPI: 1013976745
Provider Name (Legal Business Name): BRIAN PAUL RICHARDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4418
US

IV. Provider business mailing address

2359 LITTLETON CIR
COSTA MESA CA
92626-6368
US

V. Phone/Fax

Practice location:
  • Phone: 619-933-4258
  • Fax: 858-777-3387
Mailing address:
  • Phone: 619-933-4258
  • Fax: 858-777-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34538
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA043896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: